ABSTRACTS

Abstracts Nederlandse Vereniging voor Thoraxchirurgle 14 May 2004 Extrapleural pneumonectomy and high dose radiotherapy for malignant pleural mesothelioma MaatAPWM, WekkenAvd, KappeteinAP, Birim 0, Pol Mvd, Bakker M den, Klaveren RJ v, Bogers AJJC. Erasmus MC, Rotterdam.

Introduction: Due to the aggressive nature of malignant pleural mesothelioma (MM) a multimodality approach is the only potential curative option in selected patients; extrapleural pneumonectomy (EPP) is part of this treatment. Methods: Between december 2001 and july 2003 7 men (mean age 57.7, 52-64 yrs) underwent EPP followed by 54 Gy radiotherapy (RT). EPPwas performed through lateral thoracotomies with en bloc resection and reconstruction of pericardium and diaphragm. In all pts who received RT, the surgeon assisted the radiotherapist in treatment planning. Results: There was no in-hospital or 30 day mortality. In 5 pts EPP was followed by 54 Gy RT with no or major complications. In one pt the RT was delayed due to serious postoperative complications. In one pt RT was ommited due to serious post-operative complications; this pt died 7 mts post-operative. All other pts are alive (2-20 mts postoperative), only one has evidence of local and distant metastases. Conclusions: EPP followed by curative RT is feasible for the treatment ofselected patients with MM. The intensitiy of the treatment calls for well informed motivated patients and close collaboration between team members. There is a need for more accurate staging and other treatment modalities.

Pulmonary thromboendarterectomy: the Amsterdam cxperience in 32 cases Meijer RCA, Bresser P, Reesink HJ, Kloek nI. Academic Medical Center, Amsterdam.

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a relatively rare but potentially fatal disease. At this moment, pulmonary thromboendarterectomy (PTE) is the treatment of first choice, and it has been demonstrated to be a curative procedure in most patients. We started our PTE-program in 2002. Methods: The procedure was performed as described by the group of Jamieson in San Diego: a bilateral exploration and endarterectomy ofboth pulmonary arteries, with the use of ECC under deep hypothermia and intermittent circulatory arrest. Results: From June 2002 until December2003, 10 males and 22 females underwent PTE. Mean age was 48 years (range 16-78). Pre- and postoperative NYHA-dassification and hemodynamic parameters are summarised in the table. Mean duration of ECC and AoX was 327 minutes +77 minutes (range 229-704) versus 108+32 minutes (range 60-225). All surviving patients except one improved both clinically (NYHA) and hemodynamically. Of the three patients who died, one could not be weanedfom ECC due to unresolved pulmonary hypertension, one died

Pr.-PTE NYHA

11 lll IV PAP (mean) Cl TPR PVR

0 3 26 3

45 (±14) 2.4 (±0.6) 836 (±414) 542 (±308)

PostPTE 20* 8* 1* 0* 25 (±8.5) 2.6 (±0.7) 420 (±184) 256 (±140)

p-value

Abstracts Nederlandse Vereniging voor Thoraxchirurgie: 14 May 2004.

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